Prolonged hip fracture surgery is associated with increased postoperative delirium, particularly under general anesthetic

22/02/2019

The longer surgery for hip fracture repair lasts, the more likely patients are to have delirium after the operation, according to a new study by researchers at ICES and Sunnybrook Health Sciences Centre.

Postoperative delirium can be described as a state of confusion or agitation, and is common for older adults after surgery. It is unpleasant but almost always temporary. It has been linked, however, to longer stays in intensive care units, more total days in the hospital, and even a higher risk of death.

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The study published today in JAMA Network Open, showed that increasing surgery duration was associated with a higher likelihood of postoperative delirium, with the risk of delirium increasing per additional half hour of surgery. This risk was higher in patients that received a general anesthetic.

“Our findings show that nearly 11 per cent of older adults who underwent hip fracture surgery were diagnosed with postoperative delirium. We found that every half hour of additional surgery time increased the risk of postoperative delirium by six per cent,” says Dr. Bheeshma Ravi, lead author on the study, adjunct scientist at ICES and an orthopaedic surgeon with the Holland Bone and Joint Program at Sunnybrook Health Sciences Centre.

The researchers looked at the data for 68,131 patients aged 65 or older who had hip fracture surgery between April 1, 2009 and March 31, 2017 at 80 hospitals in Ontario. They found approximately 11 per cent of patients (7,150) experienced postoperative delirium.

“We found that general anaesthesia is also associated with increased risk of delirium after surgery when compared to patients who undergo regional anesthesia, such as spinal anaesthetic,” adds Dr. Ravi.

The researchers point out that the duration of surgery is affected by factors such as the complexity of the injury, the difficulty of the procedure and the technical expertise of the surgical team, and recommend that hip fractures should be managed in an expedited way by experienced surgeons and anaesthetists.

This study was generously supported by Marvin Tile Chair in Orthopaedic Surgery at Sunnybrook Health Sciences Centre.

Author block: Bheeshma Ravi, Daniel Pincus, Stephen Choi, Richard Jenkinson, David N. Wasserstein and Donald A. Redelmeier.

The report “Association of duration of surgery with postoperative delirium among patients receiving hip fracture repair,” is published in the February 22 issue of JAMA Network Open.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

About Sunnybrook
Sunnybrook Health Sciences Centre is inventing the future of healthcare for the 1.2 million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for high-risk pregnancies, critically-ill newborns and adults, offering specialized rehabilitation and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries. The Hospital also has a unique and national leading program for the care of Canada’s war veterans. For more information about how Sunnybrook is inventing the future of healthcare please visit us online at www.sunnybrook.ca.